The impact of the 7th October war on preterm birth rates and neonatal outcomes: a retrospective comparative study from northern Israel

Maternal psychological stress is associated with adverse obstetric and neonatal outcomes, including preterm birth and low birthweight. Warfare represents a significant source of acute and chronic stress, yet its impact on pregnancy outcomes remains unclear. This study aimed to evaluate the association between a 6-month period of continuous wartime exposure following October 7, 2023, during the “Iron Swords” conflict and preterm birth, neonatal outcomes, and obstetric management.

This retrospective cohort study included all deliveries at ZIV Medical Center during the 6-month conflict period, compared with a pre-war cohort from 2021 until October 6, 2023. The primary outcome was preterm birth (< 37 weeks). Secondary outcomes included early preterm birth (< 34 weeks), labor induction, mode of delivery, maternal complications, and neonatal outcomes. Multivariate logistic regression was used to identify independent predictors of preterm birth.

A total of 699 conflict-period deliveries were compared with 7821 pre-war deliveries. Preterm birth rates were similar (< 37 weeks: 6.6% vs. 5.5%; < 34 weeks: 2.1% vs. 1.5%). Labor induction was markedly lower during the conflict (oxytocin 23.7% vs. 38.7%; cervical ripening balloon 3.3% vs. 7.7%; prostaglandins 4.1% vs. 6.5%), accompanied by reduced postpartum hemorrhage (7.9% vs. 12%). Neonatal outcomes, including birthweight distribution, NICU admissions, and survival, were comparable or slightly improved.

Prolonged wartime exposure was not associated with increased rates of preterm birth or adverse neonatal outcomes. Lower rates of obstetric intervention were observed during the conflict period and coincided with lower rates of maternal complications, although causality cannot be established.